Donor site reconstruction in iliac crest tricortical bone graft: surgical technique

Caecum Rupture Secondary to Iliac Crest Bone Graft: A Case Report

Autogenous bone grafting is a common surgical method in orthopaedics. The anterior iliac crest is a common site for harvesting autologous bone grafts. There are many complications after iliac bone harvesting, and pain and discomfort at the donor site are the most common sequelae. However, intestinal rupture after iliac bone harvesting has not been reported. We report a case of caecum rupture in a 58-year-old male after harvesting bone from his iliac crest. After proper surgical repair, the patient was discharged from the ICU and his bowel function recovered. This serious complication of bone harvesting from the iliac crest prompted investigation of the technique of iliac crest harvesting and donor site reconstruction.

Scooping Technique to Acquire Cancellous Bone for Grafting in the Masquelet Procedure: A Retrospective Study

Background

The Masquelet procedure is effective in overcoming large bone defects; however, the limited number of cancellous bone and donor site complications remains a challenge. We developed a scooping technique to harvest sufficient cancellous bone from iliac crests for grafting during the Masquelet procedure. We hypothesized that this method would be efficient and safe.

Methods

This retrospective study included 13 patients who underwent the Masquelet procedure with cancellous bone grafting using the scooping technique. The following parameters were observed: (1) duration and total volume of cancellous bone extraction; (2) amount of bleeding and drainage fluid, and Visual Analog Scale (VAS) score of pain at the donor site during different periods; and (3) complications and bone regeneration at the ilium at the final follow-up.

Results

The median follow-up duration was 17 months. There were 3 unilateral and 10 bilateral extraction sites. The mean total amount extracted, extraction duration, bleeding, and drainage were 39 mL, 23 min, 49 mL, and 44 mL, respectively. Only three patients felt pain (VAS score: 1 point) at the final follow-up. Postoperatively, one case each of hematoma and lateral femoral cutaneous nerve injury supervened, and no infections or other complications occurred. The last computed tomography examination showed varying degrees of bone regeneration in the ilium.

Conclusion

The scooping technique for the iliac crest produced a substantial amount of autogenous cancellous bone using a small incision. It retained the appearance and morphology of the ilium with few complications. We believe it is a successful and safe option for treating bone defects.

Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review

Autologous bone grafting is common in trauma and orthopaedic surgery. Both the Reamer Irrigator Aspirator (RIA) and Iliac Crest Bone Graft (ICBG) aim to obtain autologous bone graft. Although the process of harvesting a bone graft is considered simple, complications may occur. This study examined morbidity and pain at the donor site, blood loss, and iatrogenic fractures, comparing RIA and ICBG. The source of the autologous bone graft, the alternative graft sites, and the storage modalities of the harvested bone marrow were also evaluated. In May 2021, PubMed, Embase, Scopus, and Google Scholar were accessed, with no time constraints. RIA may produce greater blood loss, but with less morbidity and complications, making it a potential alternative source of bone grafting.

Effect of bone graft granule volume on postoperative fusion after lumber spinal internal fixation: A retrospective analysis of 82 cases

Objective:

To investigate the effect of bone graft volume on postoperative fusion and symptom improvement in lumbar posterior lumbar fusion and internal fixation.

Methods:

A total of 82 patients receiving pedicle screw rod system internal fixation with Cage bone graft fusion in the First Hospital of Baoding City, Hebei Province were selected and randomly divided into three groups. The excised autologous laminar bones were bitten into different sizes of bone fragments. And different sizes of bone grafts were implanted during the operation. Group-A (n=28) was implanted by bone graft granule with the average volume of 0.2 cm³, Group-B (n=27) was implanted by bone graft granule with the average volume of 0.1 cm³, and Group-C (n=27) was implanted by bone graft granule with the average volume of 0.05 cm³. The bone graft granule volume, clinical effect, bone graft fusion rate and intervertebral space height were compared.

Results:

The three groups had significantly different bone graft granule volumes (P<0.05), but similar intervertebral bone graft total volumes and Cage heights (P>0.05). In the final follow-up, VAS and ODI of low back pain and two lower limbs pain significantly reduced compared with those before surgery (P<0.05), but the three groups had similar results (P>0.05). The bone graft fusions of Group-B one and two years after surgery were significantly higher than those of Group-A and Group-C, and the values of Group-A exceeded those of Group-C (P<0.05). In the final follow-up, the intervertebral space height change of Group-B was significantly smaller than those of Group-A and Group-C (P<0.05).

Conclusion:

Size of bone graft granule has no significant effect on postoperative symptoms. However, middle-sized volume bone graft granule (0.1 cm³/granule) showed increased postoperative intervertebral fusion rate and reduced intervertebral space height loss in our study.

Assessment of the degradation rates and effectiveness of different coated Mg-Zn-Ca alloy scaffolds for in vivo repair of critical-size bone defects

Surgical repair of bone defects remains challenging, and the search for alternative procedures is ongoing. Devices made of Mg for bone repair have received much attention owing to their good biocompatibility and mechanical properties. We developed a new type of scaffold made of a Mg-Zn-Ca alloy with a shape that mimics cortical bone and can be filled with morselized bone. We evaluated its durability and efficacy in a rabbit ulna-defect model. Three types of scaffold-surface coating were evaluated: group A, no coating; group B, a 10-μm microarc oxidation coating; group C, a hydrothermal duplex composite coating; and group D, an empty-defect control. X-ray and micro-computed tomography(micro-CT) images were acquired over 12 weeks to assess ulnar repair. A mechanical stress test indicated that bone repair within each group improved significantly over time (P < 0.01). The degradation behavior of the different scaffolds was assessed by micro-CT and quantified according to the amount of hydrogen gas generated; these measurements indicated that the group C scaffold better resisted corrosion than did the other scaffold types (P < 0.05). Calcein fluorescence and histology revealed that greater mineral densities and better bone responses were achieved for groups B and C than for group A, with group C providing the best response. In conclusion, our Mg-Zn-Ca-alloy scaffold effectively aided bone repair. The group C scaffold exhibited the best corrosion resistance and osteogenesis properties, making it a candidate scaffold for repair of bone defects.

Evaluation of bone graft harvesting techniques from anterior ilium

Autogenous bone harvest from the anterior ilium is a common procedure in the surgical field. In the current study, a retrospective analysis was performed regarding the bone graft harvesting techniques from the anterior ilium. The retrospective analysis with a 1-year period included 16 patients who had undergone iliac bone grafting for oral and maxillofacial reconstruction. Medial and lateral approaches were assessed. No major complications were observed. One patient undergoing medial approach and 2 patients undergoing lateral approach experienced gait disturbances at the postoperative period. Harvesting bone from the anterior ilium did not result in greater donor site morbidity or complications in the early term. The medial approach revealed an earlier recovery time than the lateral one. Anterior ilium is a good choice for the reconstruction of jaws, but donor site morbidity remains a problem and should be considered in the treatment plan.

Reconstruction of iliac crest with bovine cancellous allograft after bone graft harvest for symphysis pubis arthrodesis

PURPOSE

The aim of this study was to evaluate the safety and efficiency, as well as the incorporation characteristics of a specific type of xenograft used for iliac crest defects post-harvesting tri-cortical iliac crest bone graft.

METHODS

Sixteen patients diagnosed with chronic anterior pelvic pain were operated for pubic symphysis fusion. The tri-cortical graft harvested from the iliac crest was inserted into the pubic symphysis and compressed with a reconstruction plate. The defect in the iliac crest was filled with a block of cancellous bovine substitute (Tutobone®). The length of iliac crest defect, time to fusion of pubic symphysis, time to incorporation of the graft and complications were recorded. The postoperative pain and patients' satisfaction were evaluated.

RESULTS

The median age of patients was 36.5 years (range 27-75). Fusion was obtained in 15 patients (94 %). The median time to fusion was four months (range three to seven). The length of the iliac crest bone defect ranged from 40 to 70 mm. Integration of the bovine substitute was achieved in 15 patients (94 %) over a median period of three months (range two to six). The postoperative median pain score was 2 (range 1-5). Twelve patients (75 %) reported good satisfaction. No major complications or allergic reactions were observed.

CONCLUSIONS

The xenograft used in this study provided a safe and effective method of reconstruction of iliac crest donor site defects. It has satisfactory incorporation, high biocompatibility and no signs of inflammatory reactions. This new technique is simple and easily reproducible in routine clinical practice.

Retrospective comparison of H-graft and posterior vertebral graft procedures for the treatment of thoracolumbar burst fractures

A retrospective cohort study was conducted to compare fusion rates achieved by H-grafts, posterior vertebral grafts, and no graft for the surgical treatment of thoracolumbar fractures. Ninety-two patients were included in this study. The patients fell into 1 of 3 groups: those who received H-grafts (n=36), posterior vertebral grafts (n=30), and no graft (n=26). Mean follow-up was 38 months (range, 24-51 months). All operations were performed by a single senior surgeon. All patients underwent operative treatment with posterior reduction and instrumentation. Radiographic parameters, estimated blood loss, operative time, and length of hospital stay were compared among patients in the 3 graft groups. Differences were assessed using unpaired t tests. P values <.05 were considered significant. We found no significant difference among groups in age, fracture location, or type of fracture. Patients who received H-grafts or posterior vertebral grafts achieved solid fusion, but spontaneous fusion occurred in only 2 patients who received no bone graft. Most patients with neurological deficits showed significant neurological improvement. Operative time and estimated blood loss were significantly lower in the no-graft group than in the H-graft and posterior vertebral graft groups (P<.05). Mean loss of correction, operative time, and estimated blood loss were lower for patients who received H-grafts than for those who received posterior vertebral grafts (P<.05). The use of an atlas fixation system in combination with a posterior H-graft for the treatment of thoracolumbar fracture is a stable and reliable method that effectively prevents inner fixation failure and reduces bone loss and anisotropy.